What is the treatment for bronchitis?

Treatment of Acute Bronchitis

Antibiotics should NOT be prescribed for uncomplicated acute bronchitis, regardless of cough duration or sputum color, as they provide minimal benefit (reducing cough by only half a day) while exposing patients to unnecessary adverse effects and contributing to antibiotic resistance. 1, 2, 3, 4

Initial Assessment: Rule Out Pneumonia First

Before diagnosing acute bronchitis, assess for pneumonia by checking for:

• Tachycardia (heart rate >100 beats/min) 3
• Tachypnea (respiratory rate >24 breaths/min) 3
• Fever (oral temperature >38°C) 3
• Abnormal chest examination findings (rales, egophony, tactile fremitus) 3

Chest radiography is NOT indicated in healthy, nonelderly adults without vital sign abnormalities or asymmetrical lung sounds. 1, 5

First-Line Symptomatic Treatment

Bronchodilators (Albuterol)

Albuterol (short-acting β-agonist) is the first-line symptomatic treatment for acute bronchitis, particularly in patients with wheezing or evidence of bronchial hyperresponsiveness. 2, 3

• Reduces both duration and severity of cough 2
• Approximately 50% fewer patients report cough after 7 days of treatment 2
• Should be offered to patients with wheezing accompanying the cough 3

Antitussives

For bothersome cough without wheezing:

• Dextromethorphan or codeine provide modest effects on cough severity and duration 1, 2, 3
• These agents are more effective for cough lasting >3 weeks compared to early viral upper respiratory infections 1

Low-Risk Adjunctive Measures

• Elimination of environmental cough triggers (dust, dander) 1, 2
• Vaporized air treatments, particularly in low-humidity environments 1, 2

When Antibiotics ARE Indicated

Exception #1: Pertussis (Whooping Cough)

If pertussis is suspected or confirmed:

• Prescribe a macrolide antibiotic (such as erythromycin) 3
• Isolate patients for 5 days from start of treatment 3
• Early treatment within first few weeks diminishes coughing paroxysms and prevents disease spread 3

Exception #2: High-Risk Patients

Consider antibiotics only in:

• Elderly patients 3
• Immunocompromised individuals 3
• Patients with comorbidities (COPD, heart failure) 3
• If condition significantly worsens, suggesting bacterial superinfection 3

What NOT to Do

Do NOT prescribe antibiotics based on:

• Purulent or colored sputum - this does NOT signify bacterial infection 3, 6, 4
• Duration of cough - antibiotics are not indicated regardless of how long the cough persists 1, 2
• Patient expectation - satisfaction depends on communication, not antibiotics 1

Do NOT routinely use:

• β2-agonist bronchodilators in patients without wheezing 3
• NSAIDs at anti-inflammatory doses 3
• Systemic corticosteroids 3
• Expectorants or mucolytics - lack evidence of benefit 5

Patient Education Strategy

Set realistic expectations:

• Inform patients that cough typically lasts 10-14 days after the office visit 2, 3
• Refer to the condition as a "chest cold" rather than bronchitis to reduce antibiotic expectations 3, 4
• Explain that patient satisfaction depends on physician-patient communication rather than antibiotic prescription 1
• Discuss risks of unnecessary antibiotic use, including side effects and antibiotic resistance 3

Common Pitfalls to Avoid

• Prescribing antibiotics for uncomplicated acute bronchitis despite clear evidence showing lack of benefit 2, 5
• Failing to distinguish between acute bronchitis and pneumonia - always assess vital signs and chest examination 5
• Not providing realistic expectations about illness duration, leading to unnecessary follow-up visits or antibiotic requests 2
• Overlooking bronchodilator therapy in patients with wheezing, which has demonstrated benefit 2, 5
• Confusing acute bronchitis with acute exacerbations of chronic bronchitis - the latter may require antibiotics in specific circumstances 5, 7, 8